DESCRIPTION: (Applicant's Description) The Division of Primary Care of Harvard Medical School (HMS), the Department of Ambulatory Care and Prevention of HMS and Harvard Pilgrim Health Care (HPHC), the Brigham and Women's Hospital (BWH), Dana Farber Cancer Institute (DFCI), and Massachusetts General Hospital (MGH) propose to form an educational partnership to develop implement a Palliative Care Role Model Program to train clinical leaders in these institutions, which are core teaching for Harvard medical students and over 1,600 residents and clinical fellows annually. The purpose of this program is to change the culture of these institutions to improve the quality of end-of-life care received by dying patients and their families through improvements in education. Our strategy will enable us to integrate teaching about palliative medicine throughout the core clinical educational programs of the key disciplines in our institutions, including general internal medicine, oncology, neurology, cardiology, pulmonology, nephrology, surgery, and geriatrics. This project is part of a larger End-of-Life Care Initiative being jointly undertaken by BWH, DFCI, MGH, and HPHC. In this program, faculty in multiple disciplines from a comprehensive cancer center (DFCI), two general hospitals (BWH and MGH), and a managed care organization (HPHC) will undergo an intensive learner-centered curriculum in palliative medicine to enhance their competence in pain and symptom management, end-of-life communication issues, psychosocial assessment and treatment, ethical issues, hospice philosophy, eligibility, and services, and bereavement care. In addition, faculty will be taught state-of-the-art teaching skills to enhance their effectiveness as role models and mentors to students, residents, fellows, other clinicians, and faculty. Program participants will commit to teaching about end-of-life care in their clinical settings after completion of the curriculum, and will receive ongoing consultation about their teaching from the Program Co-Directors. Using these newly trained faculty, existing educational offerings (both required and elective) on end-of-life care for medical students and residents will be expanded, building on two highly successful learner-centered model courses developed for medical students and residents. Further educational efforts will be learner-centered, strongly oriented around the exploration and development of personal attitudes about end-of-life issues, shaped by longitudinal clinical experiences learners have with patients, and will entail a strong emphasis on skill development, intensive mentoring by clinical faculty, and rigorous clinical supervision. The impact of this comprehensive educational intervention on medical students, residents, and faculty will be evaluated using multiple measures, and information about the program and its outcomes will be widely disseminated.